Stacey F. on BirdEye a year ago
06/19/2021, 07:51 AM
DO NOT GO TO WEST HILLS EMERGENCY ROOM- BUYER BEWARE!
I went to West Hills Emergency Room- chosen since the facility as it was an in-network hospital for my Anthem PPO insurance. Upon receiving a denial of services and payment for the ER doctors bill by Anthem- even after a re-review of their decision- I am held for payment in full of the $1375.00 bill received. The bill was denied by Anthem due to an incorrect CODING issue by the ER doctor for my visit - here is why:
The ER doctor(s) at this facility are NOT contracted with Anthem Blue Cross and the ER doctors seem to bill their services at the highest rate of service, coded at level 5. Note: I saw the ER doctor for 3 minutes on my visit. I know someone else with the exact same issue/same bill and said this is the first claim ever submitted that their insurance company refused any payment.
- Anthem refuses to pay at the Level 5 coding saying the services provided in my chart does not warrant a level 5 billing/coding. They asked the ER doctor to submit with the corrected code.
- The billing dept. at West Hills Emergency Medical Association (ER doctor billing) refused to change the code which comes along with a $1375.00 charge for the services. When I expressed by frustration in my trying to get this situation corrected and paid out- the person in the billing dept. went on to explain I am not the only one with this billing issue- they had many patients where the insurance companies are denying the coding submitted for the claims. They went on to explain their policy is to accept whatever the insurance pays and in the past the insurances have paid out whatever level of services the insurance felt was warranted based on the patients charts submitted to them by the ER Doctors. Now the insurance companies are denying the charges wanting the corrected code for what they will pay out on. This issue then leaves the patient on the hook for the entire amount of the bill, when the insurance companies deny the claim with coded with level 5 treatment code for services rendered and the ER doctors/billing refuse to change the code for the services. SOUNDS LIKE LETS BILL THE MOST AND SEE WHAT WE CAN GET STRATEGY- big loser is the patient who is left holding the bag in the middle of this dispute. ER doctors at West Hills bill at the highest level waiting for any payments they can get. SCAM that only hurts the unsuspecting patient stuck in the middle of this. BUYER/PATIENT BEWARE!!
